Provider Demographics
NPI:1053347393
Name:SOUTHEAST TEXAS HEART AND LUNG SURGEONS, LLP
Entity type:Organization
Organization Name:SOUTHEAST TEXAS HEART AND LUNG SURGEONS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER-PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:LAWAYNE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:409-722-4001
Mailing Address - Street 1:2501 JIMMY JOHNSON BLVD.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2900
Mailing Address - Country:US
Mailing Address - Phone:409-722-4001
Mailing Address - Fax:409-722-4013
Practice Address - Street 1:2501 JIMMY JOHNSON BLVD.
Practice Address - Street 2:SUITE 201
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2900
Practice Address - Country:US
Practice Address - Phone:409-722-4001
Practice Address - Fax:409-722-4013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4287208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty